Introduction: Pediatric patients may be at higher risk for depression and a lower self-concept when difficulties within the family arise. The Mastering Each New Direction (MEND) program is a psychosocial intervention aimed at addressing adherence and family issues in adolescent CI. Methods: Drawing data from 50 MEND participants, we used multilevel modeling techniques to test changes in self-concept over time as predicted by number of weeks in MEND, depression, family cohesion and flexibility, and baseline levels of maternal and paternal attachment. Results: At Level 1, depression negatively predicted self-concept over time. At Level 2, higher baseline maternal and paternal avoidant attachment predicted higher initial self-concept. Higher maternal avoidant attachment was also associated with a stronger relationship between self-concept and depression. Discussion: Given that avoidant attachment predicted affective well-being and identity stabilization in youth with CI, targeting the parent-child relationship may be key to reducing co-morbid psychological issues in this population. Programs like MEND by focusing on family well-being and health may help adolescents individuate while maintaining adherence.
","abstract_html":"<p>Introduction: Pediatric patients may be at higher risk for depression and a lower self-concept when difficulties within the family arise. The Mastering Each New Direction (MEND) program is a psychosocial intervention aimed at addressing adherence and family issues in adolescent CI. Methods: Drawing data from 50 MEND participants, we used multilevel modeling techniques to test changes in self-concept over time as predicted by number of weeks in MEND, depression, family cohesion and flexibility, and baseline levels of maternal and paternal attachment. Results: At Level 1, depression negatively predicted self-concept over time. At Level 2, higher baseline maternal and paternal avoidant attachment predicted higher initial self-concept. Higher maternal avoidant attachment was also associated with a stronger relationship between self-concept and depression. Discussion: Given that avoidant attachment predicted affective well-being and identity stabilization in youth with CI, targeting the parent-child relationship may be key to reducing co-morbid psychological issues in this population. Programs like MEND by focusing on family well-being and health may help adolescents individuate while maintaining adherence.</p>","abstract_has_math":false,"creators":["Emerson, Natacha Donoghue"],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Thesis","degree_discipline":"Psychology","degree_department":null,"school":null,"contributors":["Neece, Cameron L.","Distelberg, Brian","Morrell, Holly E. R."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2016,"date_issued":"2016-06-01T07:00:00Z","date_published":"2016-06-01T07:00:00Z","updated_at":"2026-07-24T02:52:38Z","subjects":["Child Psychology","Clinical Psychology","Psychology","Social and Behavioral Sciences","Depression; Chronic Disease -- child; Pediatrics;","Parent-Child Attachment; Self-Concept; Mastering Each New Direction (MEND) Program; Avoidant Attachment"],"languages":["English"],"rights":["This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://scholarsrepository.llu.edu/etd/375","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Neece, Cameron L.","Distelberg, Brian","Morrell, Holly E. 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The author retains all other copyrights."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://scholarsrepository.llu.edu/etd/375"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Introduction: Pediatric patients may be at higher risk for depression and a lower self-concept when difficulties within the family arise. The Mastering Each New Direction (MEND) program is a psychosocial intervention aimed at addressing adherence and family issues in adolescent CI. Methods: Drawing data from 50 MEND participants, we used multilevel modeling techniques to test changes in self-concept over time as predicted by number of weeks in MEND, depression, family cohesion and flexibility, and baseline levels of maternal and paternal attachment. Results: At Level 1, depression negatively predicted self-concept over time. At Level 2, higher baseline maternal and paternal avoidant attachment predicted higher initial self-concept. Higher maternal avoidant attachment was also associated with a stronger relationship between self-concept and depression. Discussion: Given that avoidant attachment predicted affective well-being and identity stabilization in youth with CI, targeting the parent-child relationship may be key to reducing co-morbid psychological issues in this population. Programs like MEND by focusing on family well-being and health may help adolescents individuate while maintaining adherence.
"]},{"key":"dc:title","label":"Title","values":["Multi-level Model of Parent-Child Attachment, Depression & Self-Concept in Pediatric Chronic Illness"]}]}],"canonical_facts":{"dc:contributor":["Neece, Cameron L.","Distelberg, Brian","Morrell, Holly E. R."],"dc:creator":["Emerson, Natacha Donoghue"],"dc:description.abstract":["Introduction: Pediatric patients may be at higher risk for depression and a lower self-concept when difficulties within the family arise. The Mastering Each New Direction (MEND) program is a psychosocial intervention aimed at addressing adherence and family issues in adolescent CI. Methods: Drawing data from 50 MEND participants, we used multilevel modeling techniques to test changes in self-concept over time as predicted by number of weeks in MEND, depression, family cohesion and flexibility, and baseline levels of maternal and paternal attachment. Results: At Level 1, depression negatively predicted self-concept over time. At Level 2, higher baseline maternal and paternal avoidant attachment predicted higher initial self-concept. Higher maternal avoidant attachment was also associated with a stronger relationship between self-concept and depression. Discussion: Given that avoidant attachment predicted affective well-being and identity stabilization in youth with CI, targeting the parent-child relationship may be key to reducing co-morbid psychological issues in this population. Programs like MEND by focusing on family well-being and health may help adolescents individuate while maintaining adherence.
"],"dc:identifier":["https://scholarsrepository.llu.edu/etd/375"],"dc:language":["English"],"dc:rights":["This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights."],"dc:subject":["Child Psychology","Clinical Psychology","Psychology","Social and Behavioral Sciences","Depression; Chronic Disease -- child; Pediatrics;","Parent-Child Attachment; Self-Concept; Mastering Each New Direction (MEND) Program; Avoidant Attachment"],"dc:title":["Multi-level Model of Parent-Child Attachment, Depression & Self-Concept in Pediatric Chronic Illness"],"thesis:degree_discipline":["Psychology"],"thesis:degree_level":["Thesis"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T02:52:38Z"}